Abstract
The purpose of the present study was to determine whether certain foot/ankle surgeries
would benefit from the routine use of low-molecular-weight heparin (LMWH) as postoperative
deep venous thrombosis prophylaxis. We conducted a formal cost-effectiveness analysis
using a decision analytic tree to explore the healthcare costs and health outcomes
associated with a scenario of no prophylaxis and a scenario of routine LMWH prophylaxis
for 4 weeks. The 2 scenarios were compared for 5 procedures: (1) Achilles tendon repair
(ATR), (2) total ankle arthroplasty (TAA), (3) hallux valgus surgery (HVS), (4) hindfoot
arthrodesis (HA), and (5) ankle fracture surgery (AFS). The outcomes assessed included
short- and long-term costs, quality-adjusted life-years (QALYs), and incremental cost
per QALY gained. The costs were evaluated from the healthcare system perspective and
are expressed in U.S. dollars at a 2015 price base. In the short term, routine prophylaxis
was always associated with greater costs compared with no prophylaxis. For ATR, TAA,
HA, and AFS, prophylaxis was associated with slightly better health outcomes; however,
the gain in QALYs was minimal compared with the cost of prophylaxis (incremental cost-effectiveness
ratio well above $50,000/QALY threshold). For HVS, prophylaxis was associated with
both worse health outcomes and greater costs. In the long term, routine prophylaxis
was always associated with worse health outcomes and either cost more (HA, AFS, HVS)
or saved very little (ATR, TAA). We concluded that policies encouraging the routine
use of LMWH after foot/ankle surgery are unlikely to be cost-effective. Decisions
to perform prophylaxis should be on a case-by-case basis and should emphasize individual
patient risk factors.
Level of Clinical Evidence
Keywords
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Article info
Footnotes
Financial Disclosure: This research was funded by an Clinical and Scientific Research Grant (2014) from the American College of Foot and Ankle Surgeons and grant 2T35DK074390 from the National Institute of Diabetes and Digestive and Kidney Disease. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health or ACFAS.
Conflict of Interest: None reported.
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